External Ventricular Drain Insertion Accuracy

Toma, Ahmed K; Camp, Sophie; Watkins, Laurence; Grieve, Joan; Kitchen, Neil

doi:10.1227/01.neu.0000356973.39913.0b

Cited by 119 publications

(39 citation statements)

References 12 publications

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“…These studies noted accurate placement occurring in between 40 and 98% of procedures. [11, 23, 10, 7, 26, 28] Other studies did not specifically provide definitions for appropriate placement but reported accurate catheter placement rates occurring between 79 and 94%. [9, 16, 4, 12] Findings from a study that followed pediatric shunt function suggest that the local environment of the catheter tip has an effect on shunt failure.…”

Section: Discussionmentioning

confidence: 99%

“…Accuracy rates using the freehand technique have been reported between 40 and 98 percent. [11, 9, 16, 23, 10, 7, 4, 27, 26, 12, 28] These studies differ in their reporting strategies, but a grading scale has been described to assess catheter placement accuracy. The implication of multiple catheter passes have not been extensively described.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with external ventricular drain placement accuracy: data from an electronic health record repository

et al. 2013

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Background We evaluated external ventricular drain placement for factors associated with placement accuracy. Data was acquired using an electronic health record data requisition tool. Method Medical records of all patients who underwent ventriculostomy from 2003–2010 were identified and evaluated. Patient demographics, diagnosis, type of guidance and number of catheter passes were searched for and recorded. Post-procedural hemorrhage and/or infection were identified. A grading scale was used to classify accuracy of catheter placements. A multiple logistic regression model was developed to assess features associated with accurate catheter placement. Results One hundred nine patients who underwent 111 ventriculostomies from 2003–2010 were identified. Patient diagnoses were classified into vascular (63%), tumor (21%), trauma (14%), and cyst (2%). Procedures were performed freehand in 90 (81%), with the Ghajar guide in 17 (15%), and with image guidance in 4 (4%) patients. Eighty-eight (79%) catheters were placed in the correct location. Trauma patients were more likely to have catheters misplaced (p=0.007) whereas patients in other diagnostic categories were not significantly associated with misplaced catheters. Post-procedural hemorrhage was noted in 2 (1.8%) patients on post-procedural imaging studies. Five (4.5%) definite and 6 (5.4%) suspected infections were identified. Conclusions External ventricular drain placement can be performed accurately in most patients. Patients with trauma are more likely to have catheters misplaced. Further development is required to identify and evaluate procedure outcomes using an electronic health record repository.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors associated with external ventricular drain placement accuracy: data from an electronic health record repository

et al. 2013

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“…In addition to the general complications of EVD implantation as hemorrhage and obstruction, the most common misplaced catheters are basal ganglion, thalamus, internal capsula, corpus callosum, and frontal lobe. [123456891011121314151617181920]…”

Section: Discussionmentioning

confidence: 99%

Surface anatomy for implantation of external ventricular drainage: Some surgical remarks

Mostofi¹,

Khouzani

2016

Surg Neurol Int

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Background:External ventricular drainage (EVD) is an emergency process intended to reduce intracranial hypertension resulting from the obstruction of cerebrospinal fluid (CSF) flow. This creates a temporary situation to extract CSF that cannot pass through normally. Knowing the surface anatomy for EVD implantation is important to prevent its inadvertent complications. The external landmarks have been designed in this anatomic study to review the classical landmarks and come up with new landmarks to improve this simple but lifesaving procedure.Methods:From November 1998 to October 2012, we implanted 439 EVDs.Results:In the first years, we employed usual landmarks to implant 97 EVDs. Since 2002, we used modified anatomical landmarks to implant 342 EVDs directly in the third ventricle.Conclusion:Using effective landmarks for EVD implementation allows the catheter to be inserted in the third ventricle. In addition, it permits more precise accuracy to ensure a safer procedure with fewer complications.

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“…The ventricular catheter is considered as a lifelong functioning implant in the case of a shunting procedure; therefore special focus should be dedicated to the accurate positioning of the catheter as a correlation between catheter position and risk for proximal shunt obstruction is already described [2-7]. Several studies estimate the proportion of inaccuracy in the standard freehand technique to be in the range of 12.5 to 40% [2,4,8,9]. This freehand technique is based on the guidance by anatomical landmarks and the experience of the surgeon.…”

Section: Introductionmentioning

confidence: 99%

“…In selected, more complicated cases technical advances such as neuronavigation or ultrasound might be used. However, this comprises high technical and time consuming efforts within a rather short procedure [4,10-13]. Seeing this problem, a more simplified technique is needed to be applied in a wide range of procedures.…”

Section: Introductionmentioning

confidence: 99%

Guided Application of Ventricular Catheters (GAVCA) - multicentre study to compare the ventricular catheter position after use of a catheter guide versus freehand application: study protocol for a randomised trail

Schaumann

Thomale

2013

Trials

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BackgroundThe standard technique for the placement of ventricular catheters (VC) comprises a high proportion of malpositioning of the catheter (12.5 to 40%). Technical advances such as neuronavigation or ultrasound have been shown to increase the accuracy of the procedure. Since these means result in significant technical and time consuming efforts, they are used for selected cases only. In order to simplify the controlled placement of ventricular catheters a newly developed smartphone assisted guiding tool has been introduced. In this study the efficacy and safety of this guiding tool is determined.Methods/designThis study is a multicentre, randomised, controlled trial. A total of 144 patients planned for an elective shunting procedure will be enrolled throughout 10 study centres within two years. The primary objective of the trial is to show the superiority of the guided placement in comparison to the standard freehand technique of ventricular catheter application. Patients will be followed up for 30 days after the operation in regard to image-based evaluation of the catheter position as well as possible shunt dysfunction and complications.DiscussionThe Guided Application of Ventricular Catheters (GAVCA) trial compares the guided catheter positioning with the standard freehand technique of catheter placement in hydrocephalic patients. If superiority is shown, the standard technique may be changed with the advantage of a more reliable and safer positioning of the ventricular catheter with just a slight effort in time and pre-operative planning.Trial registrationThe GAVCA trial is registered at ClinicalTrials.gov under the number NCT01811589.

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External Ventricular Drain Insertion Accuracy

Cited by 119 publications

References 12 publications

Factors associated with external ventricular drain placement accuracy: data from an electronic health record repository

Factors associated with external ventricular drain placement accuracy: data from an electronic health record repository

Surface anatomy for implantation of external ventricular drainage: Some surgical remarks

Guided Application of Ventricular Catheters (GAVCA) - multicentre study to compare the ventricular catheter position after use of a catheter guide versus freehand application: study protocol for a randomised trail

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